Labeling drug addiction a choice is intellectually dishonest

By Dr. Michael Brant-Zawadzki

In recent mainstream articles, addiction has been portrayed as a habit
or a choice, instead of what it truly is – namely, a chronic, treatable
brain disease.

This misconception is both wrong and dangerous, and it flies in the face
of neuroscience, which has shown addiction to be rooted in the brain's
chemical imbalance and altered circuitry in afflicted individuals. The
habit is merely a symptom. Once that is recognized, it leads to the success
that we in the medical community see daily in our patients' battle
against addiction.

The understanding of drug addiction as a disease of the brain has been
well-documented by the medical research community for more than a decade.
Just as too much sugar can lead to a breakdown of the pancreas and the
development of diabetes, the abuse of drugs is predisposed to by the brain's
underlying makeup, and in a vicious cycle, substance abuse fundamentally
changes the brain's structure and functioning, leading to the disease
of addiction.

Powerful brain-imaging techniques repeatedly show us evidence of structural
and metabolic changes in specific areas of the brains of addicts, documenting
how drugs profoundly change brain function.

As an example, recent Magnetic Resonance Imaging studies have found that
even after a year of abstaining from drugs, women who had been addicted
to cocaine, amphetamines or methamphetamines, had significantly lower
gray matter activity in widespread brain regions of the brain compared
to women who did not abuse drugs.

Compounding the problem is the fact that repeated abuse of drugs and alcohol
can affect a person's self-control and ability to make good decisions,
all the while sending intense impulses to the brain to take more drugs.
This interplay between chemistry and behavior makes it very challenging
for a person who is addicted to stop abusing drugs — and it is why
medical intervention is so essential.

Similar to other chronic, relapsing diseases, such as diabetes, drug addiction
can be successfully managed and overcome with the combination of behavioral
therapy and proven medical interventions. At Hoag, we take this approach
so seriously that we have aligned our Addiction Treatment Centers, including
our new residential "rehab" — SolMar Recovery, with Hoag
Neurosciences Institute.

This is why we now have the only hospital-linked residential recovery
facility in the region, though we are not alone in our understanding that
the medical disease of addiction requires a medical solution.

For decades, studies have found that a comprehensive approach to addiction
works. Integrating medical interventions, including medical detox, with
longer-term cognitive behavioral medicine, medical therapy to address
co-existing mental health conditions (often self-medicated with substance
abuse) and family involvement has led to successful recovery and sobriety
for thousands of people.

As with other chronic diseases, it is not uncommon for a person to relapse
and begin abusing drugs again. Relapse is not an indication of failure
in drug addiction any more than a spike in blood sugar is a failure of
the diabetic. What it means is that active treatment should be reinstated,
adjusted, or augmented to help the individual regain control and recover.

Defining addiction as a habit, bad behavior, or a choice could potentially
divert patients from access to the comprehensive medical treatment that
they need and deserve. It is intellectually dishonest, may in fact be
counter-productive, and it does a disservice to patients and their families,
people who are seeking real, evidenced-based treatment to reclaim their
lives from the clutches of this very real and very powerful brain disease.